Effect of Weight-based versus Absolute Norepinephrine Dosing on Mortality Risk in Obese Patients with Septic Shock: An Observational, Multicohort, Retrospective Study
Authors' conclusion
Weight-based norepinephrine dosing may underestimate ICU mortality in obese patients with septic shock, especially at higher doses, distorting risk stratification and potentially influencing clinical decision-making.
Study context
- Population
- Septic shock patients in more than 300 intensive care units (ICUs) in four countries386,792 screened
- Participants
- 10,246 patients
- Exposure
- Weight-based dosing vs Absolute dosing
- Outcome
- Effect of BMI on the relationship between norepinephrine dosing strategy and ICU mortality
Methodological detailsmulticohort, six open-access data sets, generalized additive models adjusted by disease severity
- Multicohort
- Six open-access data sets
- Generalized additive models adjusted by disease severity
Main finding
As reported in the abstract
SOFA-adjusted predicted ICU mortality, obese vs nonobese
Mean difference in predicted mortality (95% CI)P value
Weight-based dosing: obese vs nonobese
14.5%(13.7–15.3%)
PAnalysis of Deviance < 0.001Absolute dosing: obese vs nonobese
0.3%(−0.1 to 0.6%)
PAnalysis of Deviance = 0.715Observational data: associations, not effects.
Further findings
Mortality divergence at higher doses, weight-based dosing
- Progressive mortality underestimation with increasing body mass index (BMI) at doses >0.3 μg · kg −1 · min −1; divergence up to 26% at 1 μg · kg −1 · min −1 between BMI 20 and 50 kg/m 2
Patients with BMI above 30 kg/m 2
- Obese patients
- 2,858 (28%)
Original publication
Effect of Weight-based versus Absolute Norepinephrine Dosing on Mortality Risk in Obese Patients with Septic Shock: An Observational, Multicohort, Retrospective Study. Anesthesiology. Published 6 May 2026. doi:10.
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